Abstract

We present a rare case of a 66-year-old male with evidence of a polypoid mass in the first section of the duodenum. He first received the diagnosis of Brunner’s gland adenoma with foci of signet-ring adenocarcinoma on
biopsy and after two months he underwent distal gastrectomy extended to the first section of duodenum. The resected specimen contained one polyp of 2.5 cm (maximum diameter). Morphological assessment and
immunohistochemistry were performed and the previous diagnosis of an infiltrating signet-ring cells adenocarcinoma arising from Brunner’s gland was confirmed. Brunner’s gland adenomas are rare tumors of the duodenum. These lesions have previously been described as  benign. Some authors described epithelial dysplasia associated with surface erosions, suggesting a malignant potential. In the literature, just few cases of adenocarcinoma originating from Brunner ’ s gland adenoma are described. As far as we know, there have been no previous reports about pure signet-ring adenocarcinomas arising from Brunner’s glands polyp. First diagnosis on biopsy is difficult and could be even more insidious within surgical specimen. This is due to extensive erosions, massive loss of surface epithelium, inflammation, fibrosis and hyperplastic changes, especially when facing with an adenocarcinoma infiltrating in a single-cells manner. Based on our experience, for patient’s better surgical and oncologic management, we think it is important to look carefully at the polyp surface while at the same time considering all the potential pitfalls.

Keywords: Duodenum, Gastrectomy, Inflammation, Fibrosis